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First-line oxygen therapy with high-flow in bronchiolitis is not cost saving for the health service
  1. Vijay S Gc1,2,
  2. Donna Franklin3,4,5,6,7,
  3. Jennifer A Whitty2,
  4. Stuart R Dalziel6,8,9,
  5. Franz E Babl6,10,11,12,
  6. Luregn J Schlapbach3,4,5,13,
  7. John F Fraser5,6,8,
  8. Simon Craig6,14,15,
  9. Jocelyn Neutze6,16,
  10. Ed Oakley6,10,11,12,
  11. Andreas Schibler3,4,5,6
  1. 1 Centre for Health Economics, University of York, York, UK
  2. 2 Norwich Medical School, University of East Anglia, Norwich, UK
  3. 3 Paediatric Critical Care Research Group, The University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia
  4. 4 Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
  5. 5 The University of Queensland Child Health Research Centre, School of Medicine, Brisbane, Queensland, Australia
  6. 6 Paediatric Research in Emergency Departments International Collaborative (PREDICT), Brisbane, Queensland, Australia
  7. 7 Critical Care Research Group, Adult Intensive Care Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
  8. 8 Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
  9. 9 Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
  10. 10 Emergency Department, Royal Children’s Hospital, Parkville, Victoria, Australia
  11. 11 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  12. 12 Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
  13. 13 Department of Paediatrics, Bern University Hospital, University of Bern, Bern, Switzerland
  14. 14 Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
  15. 15 Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
  16. 16 KidzFirst Middlemore Hospital and theUniversity of Auckland, Auckland, New Zealand
  1. Correspondence to Dr Andreas Schibler, Paediatric Intensive Care Unit, Paediatric Critical Care Research Group, University of Queensland Child Health Research Centre, South Brisbane, Queensland, Australia; a.schibler{at}


Background Bronchiolitis is the most common reason for hospital admission in infants. High-flow oxygen therapy has emerged as a new treatment; however, the cost-effectiveness of using it as first-line therapy is unknown.

Objective To compare the cost of providing high-flow therapy as a first-line therapy compared with rescue therapy after failure of standard oxygen in the management of bronchiolitis.

Methods A within-trial economic evaluation from the health service perspective using data from a multicentre randomised controlled trial for hypoxic infants (≤12 months) admitted to hospital with bronchiolitis in Australia and New Zealand. Intervention costs, length of hospital and intensive care stay and associated costs were compared for infants who received first-line treatment with high-flow therapy (early high-flow, n=739) or for infants who received standard oxygen and optional rescue high-flow (rescue high-flow, n=733). Costs were applied using Australian costing sources and are reported in 2016–2017 AU$.

Results The incremental cost to avoid one treatment failure was AU$1778 (95% credible interval (CrI) 207 to 7096). Mean cost of bronchiolitis treatment including intervention costs and costs associated with length of stay was AU$420 (95% CrI −176 to 1002) higher per infant in the early high-flow group compared with the rescue high-flow group. There was an 8% (95% CrI 7.5 to 8.6) likelihood of the early high-flow oxygen therapy being cost saving.

Conclusions The use of high-flow oxygen as initial therapy for respiratory failure in infants with bronchiolitis is unlikely to be cost saving to the health system, compared with standard oxygen therapy with rescue high-flow.

  • costing
  • health economics
  • intensive care
  • respiratory

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  • VSG and DF contributed equally.

  • Correction notice This paper has been corrected since it was published online. The sixth author's surname was mis-spelt.

  • Contributors VSG acquired health economic data, performed the economic analysis, drafted the manuscript. DF provided trial data and their interpretation. JAW conceptualised and designed the economic analysis, and supervised the economic analysis. SD, FEB, LS, JFF, SC, JN and EO contributed to the interpretation of the data. AS provided trial data and their interpretation. All authors critically revised and approved the final manuscript.

  • Funding This work was supported by a project grant (GNT1081736) from the National Health and Medical Research Council (NHMRC), Canberra, Australia, and Queensland Emergency Medical Research Fund (QEMRF), Brisbane, Australia. Regional site funding was obtained for Ipswich Hospital from the Ipswich Hospital Foundation and the Gold Coast University Hospital (GCUH) from the GCUH Foundation. The Townsville Hospital was part funded by a SERTA grant (Study, Education and Research Trust Account). JFF and AS received a research fellowship from the Queensland Health Department, Australia. PREDICT sites were supported by a National Health and Medical Research Council Centre of Research Excellence grant for paediatric emergency medicine (GNT1058560). Victorian sites received infrastructure support from the Victorian Government’s Infrastructure Support Program, Melbourne, Australia. FEB was part funded by a Royal Children’s Hospital Foundation grant, a Melbourne Campus Clinician Scientist Fellowship, Melbourne, Australia and an NHMRC Practitioner Fellowship. SD was part funded by a grant from the Health Research Council of New Zealand (HRC) and Cure Kids New Zealand, Auckland, New Zealand. The high-flow equipment and consumables for all study sites were provided free of charge by Fisher & Paykel Healthcare (Auckland, New Zealand), who had no involvement in the design, conduct and analysis of the study.

  • Competing interests LS, SC and VSG report no conflict of interest relevant to this article to disclose. JAW, JFF, JN and EO report grants from the National Health Medical Research Council (NHMRC) Australia during the conduct of the study. DF, JFF, JN, EO and AS report equipment support for the study from the Fisher & Paykel Healthcare, Auckland. JFF and AS report Queensland Health Medical Research Fellowship. FEB reports grants from the NHMRC Australia, RCH Foundation and Melbourne Campus Clinician Scientist Fellowship. DF and AS report grants from the NHMRC Australia, Queensland Emergency Medical Research Fund, Ipswich Hospital Foundation and Gold Coast Hospital Foundation. DF, JFF and AS report travel support from the Fisher & Paykel Health Care, Auckland.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Anonymised patient-level data can be made available on reasonable request to the senior author (AS) after submitting a proposal and signing a data access agreement. Consent was not explicitly obtained for data sharing, but the presented data are anonymised and the risk of identification is low.